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Reference Form
Complete the reference form and submit
Referee Details
Name
*
First
Last
Phone
*
Email
*
Job Title
Company
*
In what capacity did you know the applicant?:
*
Applicant Details
Name
*
First
Last
Job Title
Company
Date Employed from:
*
MM slash DD slash YYYY
Date Employed to:
*
MM slash DD slash YYYY
Would you re-employ this person?
*
Yes
No
Please explain why you would not re-employ them.
*
SECTION 1 - HOW WOULD YOU ASSESS THE FOLLOWING?
Please tick the relevant boxes Excellent, Good, Average, Poor
Ability to follow care plans
*
Excellent
Good
Average
Poor
Reliability, timekeeping,attendance
*
Excellent
Good
Average
Poor
Character
*
Excellent
Good
Average
Poor
Attitude
*
Excellent
Good
Average
Poor
Ability to ensure dignity is upheld
*
Excellent
Good
Average
Poor
Communication
*
Excellent
Good
Average
Poor
Relationships with colleagues
*
Excellent
Good
Average
Poor
Ability to work under own initiative
*
Excellent
Good
Average
Poor
SECTION - 2 Please answer the following questions
Please tick the relevant boxes Excellent, Good, Average, Poor
Has the applicant been subject to any disciplinary action?
*
Yes
No
Please provide details:
*
Are you aware of the applicants involvement in any safeguarding investigations previous or current .
*
Yes
No
Please provide details:
*
Are you aware of any reasons why the applicant should not be employed to work with children or vulnerable people?
*
Yes
No
Please provide details:
*
To the best of your knowledge, has the applicant been convicted or cautioned of a criminal offence?
*
Yes
No
Please provide details:
*
Additional Comments
PLEASE CONFIRM:
I can confirm that all the details provided are accurate at the time that this reference was completed. I can confirm that I am authorised to provide a reference on behalf of my organisation. I understand this reference may be shown to a third party for auditing purposes and I can confirm that Local Care Force has this organisation s consent and authorisation to disclose the contents of this reference to its end user, hirer clients. I understand that the applicant has the legal right to request a copy of their reference.
*
Check to confirm
Signature
*
Please sign here.
Official company stamp.
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Home
About us
Testimonials
Meet Our Team
Care at Home
How It Works
Care Jobs
Carers
Reablement
Slough
Staffing
Franchise
Services
Work for us
Jobs
Contact us
Log In
location
Oxfordshire
Surrey
Middlesex
Slough
Berkshire
Essex
News
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